Upper Abdominal Pain in 13 yr old

[ms. pacman]

I would love an outside perspective. Last Saturday a week ago), I went for a hike with the kids. My daughter was great, full of energy. That evening I read her a chapter from a book. Said goodnight, then at 10 pm she sent me a text from her room that she's feeling shaky. I assumed her muscles were tired from the hike, gave her water, went back to my room. I checked on her about 15 minutes later and she was shaking and said her stomach was hurting. I got her to the bathroom and sat her on a stool, and her legs were shaking so hard she couldn't keep them still. After a few minutes, my husband came up to help. We took her temperature and it was normal. Because she couldn't stop shaking, we called the after hours nurse, who said to take her to the ER. In the ER, they took a urine and blood. We were there all night. My daughter said her stomach hurt whenever she took a sip of water. When she tried to lie down, the shaking got worse and her stomach hurt and she felt sick. The shaking got better throughout the night. At 5am, the doctor said her blood looked great but she had a UTI and prescribed her antibiotics. 

The next day, she was able to doze while sitting upright but was unable to sleep in a reclining position because of the discomfort. We started antibiotics and cranberry juice. The symptoms did not improve over the next couple of days. I called the nurse who said that the urine culture tested positive to staph and to continue antibiotics. On Wednesday,  she was not better and I brought her to the doctor. At this point, my husband and I were worried about dehydration because her fluid intake/output was so low.The doctor said the current urine sample looked good but that since her symptoms didn't fit the story of a UTI, we were going to stop antibiotics and try Pepcid and Tums. She said to call back Friday.

My daughter is chipper and has energy but is still experiencing upper abdominal pain when drinking and lying down a week later. When I called the office yesterday, they said to call back Monday. I am scheduled to drive with my boys and sister down to North Carolina from Maine next Wednesday, but don't want to leave my daughter without knowing what's wrong. It seems to be a mystery what could have caused this to come on so suddenly and not go away. And I don't know what to do about my trip! What do you think?

[Pen]

Your dd is supposed to be doing what and with whom while you would be driving to NC?

[ms. pacman]

My husband works from home and would care for her and take her to any appointments.

[itsheresomewhere]

Gallbladder issues are becoming a lot more common in children especially teens. If it doesn’t improve over the weekend, I would ask the doctor to test her gallbladder.  The symptoms in kids can be different than adults.  

[Pen]

There are a lot of things it could be. And not necessarily just one. 

But

If the urine tested positive for staph I totally don’t get her being taken off antibiotics before finishing them— or unless a culture and sensitivity showed it was wrong antibiotic or an antibiotic resistant infection...? 

Maybe take her back to the ER? 

(Other things also could be gallbladder as pp says, liver, pancreas, stomach, diverticulitis, ... even heart can feel abdominal... lots of organs in that area) 

 Does your area have anything other than an ER that could see her and look for more answers over weekend?

I’m concerned about being told to “call Friday,” then when you do it turns into “Call Monday.”  Unless she were getting better and they are just following continuous improvement. 

It is probably safe to leave her with a competent father who will be at home in case of worsening. ? Unless there’s some reason you think it would not be, you can probably take your trip.  

But I’d want to push for more answers to what is wrong  ASAP 

and certainly wonder why in #%^*  she was taken off antibiotics if a urine culture showed staph  ????

Sounds like a way to create an antibiotic resistant bacterial infection   ????

ETA: Suggest you call hospital in re the antibiotics situation immediately and ask what to do now.  They may say restart the antibiotics or bring her back in to ER Or both.  This was added after thinking about it and that the ER sounds like it was more competent than the office, and already has some of the records and tests results presumably — and thus in this situation to deal with the ER even if there’s some other weekend place open. 

Edited August 3, 2019 by Pen

[TravelingChris]

A current sample that a doctor looks at in the office is not the same as a culture.  IF the culture showed staph, taking off of the antibiotics is not a good thing.  This doesn't sound right at all.  I agree with Pen, calling Friday and then saying to call Monday when all the prior history and continuing problems is not good.  I guess calling the nurse call line and getting her probably back to ER or restarting antibiotics, if you have them and then going to another doctor would be my choice.

[TravelingChris]

3 minutes ago, Medicmom2.0 said:

Upper abdominal pain is consistent with a UTI. Usually it’s lower and burning on urination; but I have seen plenty that only had upper abdominal pain or other odd symptoms.

Plus her urine grew staph.  Taking her off abx boggles my mind. I’d consider a new doctor, honestly.

And possibly another ER visit, but they’re likely to just tell you she needs a new course of antibiotics starting all over again. They presumably did a CT scan when she was there before that ruled out gallbladder.

Exactly

[JFSinIL2.0]

I would either go to urgent care or er today and ask for her urine to be cultured again...I agree, looking at the urine sample in the doc office not same as growing a culture and seeing staph.  I doubt the staph is cleared up already,  She may well need a stronger antibiotic, not being taken off them.   Also, if culture is clean, insist on ultrasound scan of gall bladder. My oldest dd suffered over a year of frequent tummy aches until doc ordered a scan...she had that malformed gall bladder removed age 15 or so.  It was full of stones, too.  So keep the gall bladder in mind, but get rechecked for staph first, since she already tested positive for it.  But don't wait until Monday, this has gone on long enough already ( and I don't trust that doc right now anyway.  )

pardon any typos, using iPad.

[ms. pacman]

22 hours ago, itsheresomewhere said:

Gallbladder issues are becoming a lot more common in children especially teens. If it doesn’t improve over the weekend, I would ask the doctor to test her gallbladder.  The symptoms in kids can be different than adults.  

Thank you for this. I will ask the doctor about this.

20 hours ago, Pen said:

There are a lot of things it could be. And not necessarily just one. 

But

If the urine tested positive for staph I totally don’t get her being taken off antibiotics before finishing them— or unless a culture and sensitivity showed it was wrong antibiotic or an antibiotic resistant infection...? 

Maybe take her back to the ER? 

(Other things also could be gallbladder as pp says, liver, pancreas, stomach, diverticulitis, ... even heart can feel abdominal... lots of organs in that area) 

 Does your area have anything other than an ER that could see her and look for more answers over weekend?

I’m concerned about being told to “call Friday,” then when you do it turns into “Call Monday.”  Unless she were getting better and they are just following continuous improvement. 

It is probably safe to leave her with a competent father who will be at home in case of worsening. ? Unless there’s some reason you think it would not be, you can probably take your trip.  

But I’d want to push for more answers to what is wrong  ASAP 

and certainly wonder why in #%^*  she was taken off antibiotics if a urine culture showed staph  ????

Sounds like a way to create an antibiotic resistant bacterial infection   ????

ETA: Suggest you call hospital in re the antibiotics situation immediately and ask what to do now.  They may say restart the antibiotics or bring her back in to ER Or both.  This was added after thinking about it and that the ER sounds like it was more competent than the office, and already has some of the records and tests results presumably — and thus in this situation to deal with the ER even if there’s some other weekend place open. 

*Not sure why my comment is showing up inside the quote

Although the urine culture was positive for staph, the primary doctor thought it might have been due to contamination from her skin. I agree with you that discontinuing the antibiotics like that was a risky move. I also was very frustrated that she told us to call back Monday even though things weren't better. What was the point of calling at all? I appreciate your thoughts very much and will continue looking for answers.

 

[ms. pacman]

20 hours ago, Medicmom2.0 said:

Upper abdominal pain is consistent with a UTI. Usually it’s lower and burning on urination; but I have seen plenty that only had upper abdominal pain or other odd symptoms.

Plus her urine grew staph.  Taking her off abx boggles my mind. I’d consider a new doctor, honestly.

And possibly another ER visit, but they’re likely to just tell you she needs a new course of antibiotics starting all over again. They presumably did a CT scan when she was there before that ruled out gallbladder.

 

It boggles my mind too! No imaging has been done at all.

20 hours ago, TravelingChris said:

A current sample that a doctor looks at in the office is not the same as a culture.  IF the culture showed staph, taking off of the antibiotics is not a good thing.  This doesn't sound right at all.  I agree with Pen, calling Friday and then saying to call Monday when all the prior history and continuing problems is not good.  I guess calling the nurse call line and getting her probably back to ER or restarting antibiotics, if you have them and then going to another doctor would be my choice.

 

I was so frustrated by her putting me off until Monday, because each day feels like forever when she's suffering. Also, 8 days is too long for these symptoms to be going on without being looked into further. 

17 hours ago, JFSinIL2.0 said:

I would either go to urgent care or er today and ask for her urine to be cultured again...I agree, looking at the urine sample in the doc office not same as growing a culture and seeing staph.  I doubt the staph is cleared up already,  She may well need a stronger antibiotic, not being taken off them.   Also, if culture is clean, insist on ultrasound scan of gall bladder. My oldest dd suffered over a year of frequent tummy aches until doc ordered a scan...she had that malformed gall bladder removed age 15 or so.  It was full of stones, too.  So keep the gall bladder in mind, but get rechecked for staph first, since she already tested positive for it.  But don't wait until Monday, this has gone on long enough already ( and I don't trust that doc right now anyway.  )

pardon any typos, using iPad.

 

Th doctor was going with the idea that she doesn't really have a UTI, and that the staph was from her skin. I will be pushing for more thorough investigation. I can't believe your daughter suffered for so long! Thank you so much for your insights.

[Pen]

https://www.ncbi.nlm.nih.gov/pubmed/6377440/

 

[Pen]

When dd said her stomach hurt, did she mean stomach or abdomen?  Does she know where her stomach is?  It sounds like primary took “stomach” to be stomach hence Tums. While ER and people on here are taking it to mean something in abdomen, unknown exactly what. 

[Pen]

Can she drink something other than water?

for example if not sensitive to milk can she drink (or sip) warmed milk without pain? 

[Aura]

Upper abdominal pain when drinking (especially water) and lying down does make me think of some kind of digestive issue like reflux. If that's what the doctor is thinking, then the Tums & Pepcid makes sense. But it doesn't make sense in light of her earlier symptoms like the shaking or the staph. So that makes me wonder if the doctor fixated on an easily identifiable issue and dismissed the others? 

Does she feel better w/ the Tums & Pepcid? Like Pen, I'm wondering if it's only or mostly water that gives her issue. Can she drink milk?  

The shaking makes me wonder about sugar levels. I get very shaky when my sugar levels drop.

There are a lot of questions, and I'd be wanting more than "come see me on Monday" too. If she's not feeling better, I think I'd be heading to the ER again. Sorry you're going through this.

[bluemongoose]

I get uncontrollably shaky and have stomach pain with anxiety/panic attacks... Just another thought.

[Spryte]

Her urine culture grew staph.  I would want to finish the abx, and add Pepcid or Tums as well.

Cautionary tale:  I have suffered for months with multiple issues (salmonella, then C Diff, then UTI, then kidney infection, and an ovarian cyst or two ruptured in that time period, to ice the cake).  The UTI part was miserable.  I had intense upper abdominal pain as it moved to my kidneys.  None of the usual UTI symptoms.  Ouch.  Like ER type pain.  The first ER missed the UTI. A week later it was diagnosed and I was put on abx for the UTI - which didn’t touch it. Another ER visit and a different abx ... with pain meds and Prilosec, and still taking C Diff meds ... even then it took every bit of the ten days of the effective abx for the UTI to improve.

A UTI that moves to the kidneys can be serious, as well as painful.  In your shoes, I’d want a full round of abx, and at the very least another urine culture. And keep in mind that a fairly high percentage of UTIs aren’t affected by certain abx.  

I hope she feels better soon!

...oh!  One last thought... if they do a scan, check out the radiology site called image wisely (something like that)... helps you track how many scans you’ve had.  I have been in hospital 4 times this summer, and had 5 scans altogether.  Radiologist gave me the site info.  🙂

[ms. pacman]

I just wanted to give an update to say that my daughter had an abdominal x-ray that showed constipation. They said to give her 5 capfuls (!) of Miralax to do a clean-out. The problem is, she could not choke down the mixture because of her symptom of pain when drinking fluids. Someone asked if it was just water, and it is not. Everything she drinks is bothering her. My husband called the nurse line this morning and told them what was going on, and they said to try half a square of ex lax, which I just gave her. The thing is, she says she is not constipated at all! She says she has been having a normal bm every day, without struggle. 

I truly appreciate everyone's thoughts, and I'm sorry I have been distracted and haven't replied before now. This is day 12 of ongoing symptoms, and now we're heading into another weekend with no relief. 

I have had discussions with her about stress, and she did report feeling stressed out the night that this first happened but not sure that would last this long, and only in certain positions? I'm still holding the idea of it being a UTI in the back of my head. Spryte, thank you for the name of that radiology site.

[catz]

1 hour ago, ms. pacman said:

I just wanted to give an update to say that my daughter had an abdominal x-ray that showed constipation. They said to give her 5 capfuls (!) of Miralax to do a clean-out. The problem is, she could not choke down the mixture because of her symptom of pain when drinking fluids. Someone asked if it was just water, and it is not. Everything she drinks is bothering her. My husband called the nurse line this morning and told them what was going on, and they said to try half a square of ex lax, which I just gave her. The thing is, she says she is not constipated at all! She says she has been having a normal bm every day, without struggle. 

I truly appreciate everyone's thoughts, and I'm sorry I have been distracted and haven't replied before now. This is day 12 of ongoing symptoms, and now we're heading into another weekend with no relief. 

I have had discussions with her about stress, and she did report feeling stressed out the night that this first happened but not sure that would last this long, and only in certain positions? I'm still holding the idea of it being a UTI in the back of my head. Spryte, thank you for the name of that radiology site.

You can certainly be constipated while still going regularly.  I would trust the x-ray.  I have IBS and stress can play into it.  Things that have helped over the long term are daily probiotics, gentle fiber (I like ground flax), regular exercise, good stress management.  I added instant calm (mag supplement) recently and that also seems to be helpful.  Generally clean whole food leaning diet.  Avoid processed sugars.  I think stress/anxiety and gut issues can really get on a negative feedback loop.  Feely crappy is stressful and can cause anxiety too.  Treatment for anxiety can help if that's an ongoing issue.

I'm also curious about the UTI thing.  I'm not sure why they wouldn't have had her finish her course of ABX even if her urine looked good?  That said, if she was having stomach issues prior to the UTI, the abx could really do a number on that and make it worse.  

[ktgrok]

I wonder if it is esophageal spasms. You need fluoroscopy to show that. It's intense and to me feels more like labor than anything else. Like, your body is contracting hard against your control and it HURTS. For me, it is definitely worse when swallowing when I'm having a flare. 

Has she been to a gastroenterologist? If not, that needs to be done ASAP and she needs an endoscopy ASAP. 

[Pen]

4 hours ago, FuzzyCatz said:

You can certainly be constipated while still going regularly.  I would trust the x-ray.  I have IBS and stress can play into it.  Things that have helped over the long term are daily probiotics, gentle fiber (I like ground flax), regular exercise, good stress management.  I added instant calm (mag supplement) recently and that also seems to be helpful.  Generally clean whole food leaning diet.  Avoid processed sugars.  I think stress/anxiety and gut issues can really get on a negative feedback loop.  Feely crappy is stressful and can cause anxiety too.  Treatment for anxiety can help if that's an ongoing issue.

I'm also curious about the UTI thing.  I'm not sure why they wouldn't have had her finish her course of ABX even if her urine looked good?  That said, if she was having stomach issues prior to the UTI, the abx could really do a number on that and make it worse.  

 

All  of this.

to me the original symptoms didn’t seem impossible for UTI — assuming pain was abdominal, not literally in stomach 

infection has caused me to have shakiness even without fever in my life — and even though pain when urinating or lower pain might be more common, upper abdominal can be what hurts during UTI 

 

The swallowing problem seems like something different, likely esophagus related 

has it been nearly 2 weeks and she can’t eat or drink properly?  That itself would concern me. 

Does she need some IV fluids?  

[ms. pacman]

16 hours ago, FuzzyCatz said:

You can certainly be constipated while still going regularly.  I would trust the x-ray.  I have IBS and stress can play into it.  Things that have helped over the long term are daily probiotics, gentle fiber (I like ground flax), regular exercise, good stress management.  I added instant calm (mag supplement) recently and that also seems to be helpful.  Generally clean whole food leaning diet.  Avoid processed sugars.  I think stress/anxiety and gut issues can really get on a negative feedback loop.  Feely crappy is stressful and can cause anxiety too.  Treatment for anxiety can help if that's an ongoing issue.

I'm also curious about the UTI thing.  I'm not sure why they wouldn't have had her finish her course of ABX even if her urine looked good?  That said, if she was having stomach issues prior to the UTI, the abx could really do a number on that and make it worse.  

 

Thank you for the suggestions! I was talking with her again last night about the possibility of stress contributing to her symptoms. I have some Calm powder, and I will start to give her some in the evenings again. Great idea. I also would think that we should complete the course of antibiotics, but the doctor said to stop immediately, and that it wasn't doing her any favors for her stomach.

16 hours ago, Ktgrok said:

I wonder if it is esophageal spasms. You need fluoroscopy to show that. It's intense and to me feels more like labor than anything else. Like, your body is contracting hard against your control and it HURTS. For me, it is definitely worse when swallowing when I'm having a flare. 

Has she been to a gastroenterologist? If not, that needs to be done ASAP and she needs an endoscopy ASAP. 

 

She has not been to a gastro doctor. I am hoping we'll get a referral if her symptoms don't improve! I don't know if she's experiencing spasms or not. She says there is a sharp pain and an "overfull" feeling when she drinks, but lately it's been less pain and more the discomfort.

11 hours ago, Seasider too said:

Yes you can keep having bm’s with constipation, and the symptoms actually are often first mistaken as UTI (before a urine culture rules that out). 

The miralax worked for my kid with that issue. Maybe applesauce? 

Sorry I have no suggestions about the swallowing difficulty, but that seems important for the doc to figure out. 

 

I agree that I want the other symptoms looked into also! We are trying ex lax right now to see if she can get some relief.

11 hours ago, Pen said:

 

All  of this.

to me the original symptoms didn’t seem impossible for UTI — assuming pain was abdominal, not literally in stomach 

infection has caused me to have shakiness even without fever in my life — and even though pain when urinating or lower pain might be more common, upper abdominal can be what hurts during UTI 

 

The swallowing problem seems like something different, likely esophagus related 

has it been nearly 2 weeks and she can’t eat or drink properly?  That itself would concern me. 

Does she need some IV fluids?  

 

I think at this point she is getting enough fluids. She is back to urinating several times a day. And yes, we are on Day 13, heading into another weekend 😞 She is eating fairly normally, but drinking less than normal.

[ktgrok]

Does your insurance require a referral? If not, I'd call a pediatric gastroenterologist on Monday to get the ball rolling. They will have more tools and tricks to get her feeling better even if it is constipation, and if it is more than that they will know how to find out. If you do need a referral than on Monday you need to call the primary care doctor and specifically ask for a referral. 

[ms. pacman]

On 8/9/2019 at 8:37 AM, Ktgrok said:

Does your insurance require a referral? If not, I'd call a pediatric gastroenterologist on Monday to get the ball rolling. They will have more tools and tricks to get her feeling better even if it is constipation, and if it is more than that they will know how to find out. If you do need a referral than on Monday you need to call the primary care doctor and specifically ask for a referral. 

 

At my husband's insistence, the pediatrician's office is giving us a referral to a pediatric gastroenterologist, just as you suggested. If they don't get back to me in the next day or so I am just going to call myself as we don't actually need a referral. Thanks for your advice!

[ktgrok]

1 hour ago, ms. pacman said:

 

At my husband's insistence, the pediatrician's office is giving us a referral to a pediatric gastroenterologist, just as you suggested. If they don't get back to me in the next day or so I am just going to call myself as we don't actually need a referral. Thanks for your advice!

I hope all goes well! GI doctors are just so much better at figuring this all out. 

[ms. pacman]

Thanks!

[JFSinIL2.0]

Did you great an appointment yet?  I hope she is feeling better.  

[mmasc]

@ms. pacman How is she? I hope she’s much better!

[Pen]

On 8/13/2019 at 2:22 PM, ms. pacman said:

Thanks!

 

Also wondering how she is—and whether you got to go on trip or stayed home because of dd situation.  

[ms. pacman]

Thanks for checking in! This whole thing has been frustrating. She has an appointment with a GI specialist, but not until September 18. This has been going on for 3.5 weeks now, and now we are looking at another month until she is seen. I have called other specialists, but they require a physician's referral even though my insurance doesn't. I just called the pediatrician's office yesterday to ask if there really isn't something else they can do in the meantime, and the only thing they offered was to take another x-ray to see if she's still constipated. 

As for her symptoms, drinking water is much, much better now. She still can't lie down without feeling very sick. In addition, she now has stomach aches that comes and go all day. Each one lasts for up to 2 hours and they vary in severity.

[ms. pacman]

1 minute ago, Pen said:

 

Also wondering how she is—and whether you got to go on trip or stayed home because of dd situation.  

 

Pen, I stayed home from the trip.

[Pen]

14 minutes ago, ms. pacman said:

Thanks for checking in! This whole thing has been frustrating. She has an appointment with a GI specialist, but not until September 18. This has been going on for 3.5 weeks now, and now we are looking at another month until she is seen. I have called other specialists, but they require a physician's referral even though my insurance doesn't. I just called the pediatrician's office yesterday to ask if there really isn't something else they can do in the meantime, and the only thing they offered was to take another x-ray to see if she's still constipated. 

As for her symptoms, drinking water is much, much better now. She still can't lie down without feeling very sick. In addition, she now has stomach aches that comes and go all day. Each one lasts for up to 2 hours and they vary in severity.

 

I’ve been watching the free this week  docuseries on chronic illness I posted and noted that the people interviewed on it seem to think a lot of mystery illness may have roots in gut health — with so far suggestions being made to go off gluten, sugar, processed foods, tomato, ____  for 30 days (off all of those, not one at time), and on certain foods and supplements to see if it helps.

given that you can’t get her seen for almost a month maybe that sort of thing would be worth trying in meantime.